A new study has found that giving children up to one year old a sweet solution before jabs reduces the pain of the immunisation, providing a scientific basis for Mary Poppins’ maxim that “a spoonful of sugar helps the medicine go down.”
The meta-analysis looked at fourteen randomised controlled trials that assessed the effects of oral sucrose, glucose, or another sweet solution compared with placebo (water) or no treatment during 1674 injections in infants aged 1-12 months.
Thirteen (92.9%) of the trials found that the sweet solutions reduced various behavioural indicators of pain, such as crying, during and after immunisation compared with placebo. In the fourteenth study, the effects of a sucrose solution were only evident during a single immunisation and not for the second and third injections. The pain reduction was largely seen after the procedure had been completed rather than during the procedure.
Although the sweet solutions reduced behavioural signs of pain, they had less of an effect on physiological signs: none of the studies found that glucose or sucrose solutions reduced heart rate in infants during immunisation. On the other hand, one study found that infants who received a glucose solution (and were allowed to suck on a dummy) had lower levels of cortisol, the stress hormone,in their saliva after immunisation than infants who received water (with or without a dummy).
When data from the studies were pooled, sweet solutions were found to reduce the incidence of crying by 20%, the proportion of crying time by 10%, and the duration of crying time by 12 seconds compared with placebo.
The 14 studies all used different volumes and concentrations of sucrose and glucose, so the authors were not able to determine an optimal dose of sweet solution to be used in infants during immunisation. However, the findings did imply that more concentrated sugar solutions – for example, 50% sucrose in water – are more effective.
The authors recommend that “sucrose or glucose along with other recommended physical or psychological pain reduction strategies, such as non-nutritive sucking [e.g. using a dummy], breast feeding or effective means of distraction, should be consistently utilised for immunisation.”
Harrison D et al. (2010) Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Archives of Disease in Childhood DOI: 10.1136/adc.2009.174227